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Facing the loss
of one or both breasts can be very
traumatic. Every women diagnosed with breast
cancer should be given information about
reconstructive options as part of her breast
cancer treatment.
Almost any woman who loses her breast can
have it rebuilt through reconstructive
surgery. And discussion about reconstruction
can start immediately after diagnosis.
The decision to undergo breast
reconstruction is an intensely personal one.
The decision should be made by the patient,
not by treating physicians. It really is a
quality of life issue. And it doesn't matter
how old the patient is or if they're married
or single.
There are several surgical approaches to
reconstructing a totally or partially
missing breast. The choice of technique
depends on age, health, the state of the
remaining tissue, surgical scars, skin
thickness, radiotherapy treatments, the
shape and volume of the breast to be
reconstructed and the remaining breast, etc.
Reconstruction may be simple, involving
nothing more than the insertion of an
implant, or more complex. In some cases, for
instance, it may be necessary to replace
local tissue with tissue from elsewhere in
the body (a flap of skin or of skin and
muscle). Step-by-step reconstruction is
another option, for instance to adjust the
size of the other breast, rebuild the nipple
and so on.
Flap reconstruction is a more complex
procedure than skin expansion. Scars will be
left at both the tissue donor site and at
the reconstructed site, and recovery time is
longer than with an implant. However, when
the breast is reconstructed with one's own
tissue, the results are generally more
natural and concerns related to implants are
non-existent.
Skin expansion
This common technique combines skin
expansion and subsequent insertion of an
implant. Following mastectomy, a balloon
expander will be inseted beneath the skin
and chest muscle. Through a tiny valve
mechanism buried beneath the skin, he or she
will periodically inject a salt-water
solution to gradually fill the expander over
several weeks or months. After the skin over
the breast area has been sufficiently
stretched, the expander is removed in a
second operation and a more permanent
implant -- either saline or silicone -- will
be inserted. Some expanders are designed to
be left in place as the final implant. The
nipple and dark skin surrounding it --
called the areola -- are reconstructed in a
subsequent procedure.
Flap reconstruction
An alternative approach to implant
reconstruction involves creation of a skin
flap using tissue taken from other parts of
the body, such as the abdomen, back or
buttocks. In one type of flap surgery, the
tissue remains attached to its original
site, retaining its blood supply. The flap,
consisting of skin, fat and muscle with its
blood supply, are tunneled beneath the skin
to the chest, creating a pocket for an
implant or, in some cases, creating the
breast mound itself without need for an
implant.
Another flap technique uses tissue that is
surgically removed from the abdomen, thighs
or buttocks and then transplanted to the
chest by reconnecting the blood vessels to
new ones in that region.
Recovery times for both procedures range
from six months to one year, or longer,
depending on individual circumstances.
Not all women are good candidates for breast
reconstruction. Women who have had a
mastectomy or Lumpectomy with radiation are
typically not strong candidates for skin
expansion reconstruction. Radiation changes
the characteristics of skin tissue, causing
a variety of complications ranging from
excessive scar tissue development, to blood
supply and overall healing problems. While
radiation does present some difficult
challenges, it doesn't automatically rule
out the possibility of reconstruction. While
each circumstance is different, if there is
enough good tissue to work with,
reconstruction remains a viable option for
most women.
Patients that are emotionally unstable
should probably postpone reconstruction.
Coping with the reality of breast cancer is
an extremely overwhelming process. If a
woman cannot understand the risks and
limitations of reconstruction prior to her
mastectomy surgery, I would recommend she
wait.
Managing Misconceptions
Most misconceptions regarding breast cancer
reconstructionare caused by a lack of
information. Common misconceptions include
having to wait up to one year to safely
undergo reconstruction, reconstruction makes
it difficult to identify cancer if it
recurs, and reconstruction interferes with
cancer treatments, such as chemotherapy. All
are wrong on all counts.
Reconstruction can take place immediately
following mastectomy with little
complication. In the case of implants,
reconstruction may take longer if the
patient has to undergo chemotherapy, but
otherwise doesn't interfere with the
process.
Managing Expectations
It is important to remember that the goal of
reconstruction is improvement, not
perfection. Be sure to discuss your
expectations candidly with your plastic
surgeon, and expect nothing less than total
honesty from him or her in return. To ensure
reconstructive surgery has the desired
outcome, breast symmetry procedures –
surgery to the other breast -- is usually
also part of the reconstructive process.
Symmetry procedures either reduce, lift or
reshape the remaining breast to ensure a
better match to the reconstructed breast.
Symmetry procedures can be an ongoing
process, with periodic adjustments necessary
to correct the affects of the aging process.
The information on this web site is only
intended as an introduction to this
procedure and should not be used to
determine whether you will have the
procedure performed nor as a guarantee of
the result.
The best method of determining your personal
options is to schedule a personal
consultation with Dr. Makki. He will be able
to answer specific questions related to your
situation.
Please don't hesitate to call for any
questions that you might have
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